Taking wysolone for erythroderma. Found water retention in chest. Is the prescribed medicine safe?

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Question: The patient had some skin allergy which was diagnosed to be erythoderma and was being treated with wysolone starting initially with 30 mg now gradually reduced to 2.5 mg alternate day with some other medicine to control the side effects. Now either because of the side effectsof steroids or because od old age factor some damage has been noticed in the heart causing retention of water in chaste and the body as as shown in the echo test. The patient is being treated presently with following medicines:
1. Cardace 2.5 mg once a day
2. Echosprin 75 in the heart
3. Metalor
4. Dytor 10 or Lacix 20 mg once a day
5. Shelcal 500
6. Orofer

Now kindly advice whether treatment is going on in right direction and also advice as to whether dytor or lacix is better and also suggest medicinnes to compensate the loss caused by lacix or dytor

Answered by Dr. Madhuri Patil 8 hours later

Hi there.

The treatment is absolutely in right direction and as per standard guidelines for a person with heart failure.As of now the Cardiologist would prefer giving him dytor tablet due to its preferencial action during heart failure over tab Lasix. For cost factor, later the patient can be put on maintenance dose of lasix once the patient is discharged stable.Generally more water is lost in the urine than useful metabolites when diuretics are used and hence there is no nutritional supplement advised while using them.I hope you got the answer. Please get back for any related query.

How can we know whether the medicines are responding positively? The patient is getting weaker and at times unable to stand on his own. How long the patient is likely to be treated with the medicines? Can these medicines be continued for further whole life without side effectsor further deterioration. Suggest some food supplements to increase energy level.

Answered by Dr. Madhuri Patil 24 minutes later

You will come to know about patient's improvement like this:

- Patient's ejection fraction(EF) of the heart (capacity of heart to pump out blood into blood vessels for proper body functioning) improves as checked by Echocardiography- Patient can breath normally without help - Patient can eat and speak without gasps- If patient's kidney functions (creatinine and blood urea) were bad due to heart failure then they improve with patient's improvement

Patient being a known case of HF, he'll have to take these medications for lifelong. But if EF improves dramatically then the doctors will cut down the diuretics for sure.

He also seems to have anemia as he's been treated with tab Orofer. A patient treated for HF has to be clinically seen and then only given dietary advice. I cannot advise any food supplements without seeing the patient for two reasons- one because the need of dietary proteins and electrolytes like sodium and potassium keeps changing from day to day when the patient is in HF and depending on the body dynamics the doctor suggest whether to give normal food or food with extra proteins or food with less proteins. Same about electrolytes.Second reason is other than multivitamin and iron supplements ( which already he's on) other dietary supplements (which also contain carbohydrates, fats and proteins) might not be good for him as his kidney and heart functions might show fluctuations without imrpovements.I hope you understand. Please consult a good Cardiologist on this issue and let him/ her suggest by his/ her clinical assessment on dietary supplements.Take care.

Dose of Dytor is 10 mg a day, is it alright or can be increased or reduced? How long one can survive with such conditions of heart?

Answered by Dr. Madhuri Patil 32 minutes later

The dose is alright. Dose changes are again the cardiologist's decision depending on how the patient is doing clinically. If the EF is less than 30% then the chances of survival are lesser compared to that of 40 to 55% of EF. But one cannot just comment on precise survival time of a patient without seeing him/ her.To be honest, his age and weakness due to HF and anemia are the factors which lessen the chances of survival.I hope and pray for the best.

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